Organization
MILLER DENTAL GROUP POOLER LLC
Active
Other names
Miller Dental Group
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KRISTY SOLOMON (OFFICE MANAGER)
(912) 330-6000
Entity
Organization
Contact information
Practice address
103 PARK AVE STE 200, POOLER, GA 31322-4262
(912) 330-6000
Mailing address
103 PARK AVE STE 200, POOLER, GA 31322-4262
(912) 330-6000
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
1223D0001X
Public Health Dentistry
—
—
1223E0200X
Endodontics
—
—
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0221X
Pediatric Dentistry
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
122400000X
Denturist
—
—
124Q00000X
Dental Hygienist
—
—
126800000X
Dental Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1538518774
NPPES
—
01
—
1578782702
NPPES
—
Enumeration date
11/14/2019
Last updated
08/13/2020
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